title: Obesity increases risk for pouch-related complications following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA).
abstract: OBJECTIVE
  Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA.
  
  
  METHODS
  This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI < 30 (non-obese) and BMI ≥ 30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate.
  
  
  RESULTS
  A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 % vs. 64%, p = 0.03), primarily accounted for by increased pouch-related complications (61% vs. 26%, p < 0.01). In particular, obese patients had more anastomotic/pouch strictures (27% vs. 6%, p < 0.01), inflammatory pouch complications (17 % vs. 4%, p < 0.01) and pouch fistulas (12% vs. 3%, p = 0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR] = 2.86, p = 0.01) for pouch-related complications.
  
  
  CONCLUSIONS
  Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors.forename: Coen L
authors.initials: CL
authors.lastname: Klos
authors.forename: Bashar
authors.initials: B
authors.lastname: Safar
authors.forename: Nida
authors.initials: N
authors.lastname: Jamal
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hunt
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Birnbaum
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mutch
authors.forename: Sekhar
authors.initials: S
authors.lastname: Dharmarajan
mesh_terms: D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015992:Body Mass Index; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D009765:Obesity / Q000150:complications*; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D012003:Rectal Fistula / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D001747:Urinary Bladder Fistula / Q000209:etiology; D014624:Vaginal Fistula / Q000209:etiology
chemical_list: D007155:Immunologic Factors